Bictegravir/emtricitabine/tenofovir alafenamide for HIV: a meta-analysis of efficacy across treatment-naïve and experienced populations and comparative effectiveness versus dolutegravir/lamivudine

Objectives Bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is a preferred single-tablet regimen for HIV treatment, but head-to-head meta-analytic comparisons between treatment-experienced (TE) and treatment-naïve (TN) individuals are lacking. Additionally, the comparative effectiveness of BIC/FTC/TAF versus dolutegravir/lamivudine (DTG/3TC) remains to be systematically synthesized. We aimed to systematically compare the efficacy of BIC/FTC/TAF between TE and TN people with HIV, and evaluate the comparative effectiveness of BIC/FTC/TAF versus DTG/3TC. Methods We searched PubMed, Cochrane Library, Web of Science, and Embase up to September 2026. Observational studies and randomized controlled trials (RCTs) reporting virologic suppression or treatment discontinuation rates in both TE and TN populations receiving BIC/FTC/TAF, or BIC/FTC/TAF versus DTG/3TC were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Single-group proportion meta-analyses used a random-effects model, whereas comparative meta-analyses used the prespecified fixed-effect model. Results Thirty-one studies were included. For TE participants, the pooled virologic suppression rate was 95% (95% CI: 92%–97%) at 12 months, and for TN participants, the rate was 90% (95% CI: 85%–94%). In design-stratified comparative analyses between BIC/FTC/TAF and DTG/3TC, no statistically significant difference was detected in RCT (OR = 1.46, 95% CI: 0.80–2.66) or cohort studies (OR = 0.98, 95% CI: 0.70–1.39) among TN populations, nor in TE populations (RCT: OR = 1.04, 95% CI: 0.34–3.16; cohort: OR = 0.92, 95% CI: 0.42–2.02). No statistically significant differences were detected for treatment discontinuation (all-cause: OR = 1.02, 95% CI: 0.70–1.49; adverse events: OR = 1.11, 95% CI: 0.55–2.22). Conclusion BIC/FTC/TAF achieves high virologic suppression rates and low discontinuation rates in both TE and TN populations, supporting its use as a first-line and switch option. BIC/FTC/TAF and DTG/3TC showed no statistically significant differences in virologic suppression or treatment discontinuation, suggesting both are viable guideline-preferred options. The choice between them should be individualized based on patient characteristics, including prior treatment history, adherence potential, comorbidity profile, and metabolic risk considerations.